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Left ventricular diastolic dysfunction in liver transplantation: a stronger association with non-alcoholic
Hemnishil K Marella1, Faisal Kamal2, Rahul Peravali3
1Department of Medicine, University of Tennessee Health Science Center, Memphis TN, USA.
Insights
Non-alcoholic steatohepatitis (NASH) and female gender are key risk factors for left ventricular diastolic dysfunction (LVDD) in liver transplant candidates. LVDD did not impact immediate post-transplant outcomes or 30-day mortality in this patient group.
Area of Science:
- Cardiology
- Hepatology
- Transplant Surgery
Background:
- Cardiovascular complications, particularly left ventricular diastolic dysfunction (LVDD), are significant causes of mortality in end-stage liver disease (ESLD) patients undergoing orthotopic liver transplantation (OLT).
- LVDD, a manifestation of cirrhotic cardiomyopathy, requires understanding its risk factors and post-operative impact in ESLD patients.
- Early identification of LVDD risk factors is crucial for improving outcomes in OLT recipients.
Purpose of the Study:
- To identify risk factors associated with LVDD in patients with ESLD undergoing OLT.
- To evaluate the immediate impact of LVDD on post-operative outcomes and 30-day mortality in OLT recipients.
Main Methods:
- Retrospective review of electronic medical records for 100 consecutive OLT patients.
- Evaluation of transthoracic echocardiogram reports for LVDD using 2016 ASE/EACVI guidelines.
- Comparison of clinical, demographic variables, cardiac arrhythmias, and 30-day mortality between patients with and without LVDD.
Main Results:
- Patients with LVDD were older (62.7 years) and more frequently female (57%).
- Non-alcoholic steatohepatitis (NASH) was significantly associated with LVDD (48% vs. 12%, p=0.001).
- Alcoholic liver disease was less likely associated with LVDD (10% vs. 33%, p=0.032).
- Independent predictors for LVDD included NASH (OR=4.4) and female gender (OR=3.31).
Conclusions:
- NASH is an independent predictor of LVDD in ESLD patients undergoing OLT.
- Female gender is also an independent predictor of LVDD in this patient population.
- LVDD did not significantly influence immediate post-transplant outcomes or 30-day all-cause mortality in the studied cohort.
Aim Of The Study:
Cardiovascular death is an important cause of mortality in end stage liver disease (ESLD) patients undergoing orthotopic liver transplant (OLT). Left ventricular diastolic dysfunction (LVDD) is often the early manifestation and only measurable manifestation of cirrhotic cardiomyopathy. Therefore, it is important to understand the risk factors for LVDD in ESLD patients undergoing OLT and its immediate impact post-operatively.
Material And Methods:
Electronic medical records (EMR) of 100 consecutive patients who underwent OLT were reviewed at the University of Tennessee/Methodist University Hospital in Memphis, Tennessee, USA. Transthoracic echocardiogram (TTE) reports were accessed to evaluate for LVDD based on the latest 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. The clinical and demographic variables were obtained and variable quality measures, incidence of cardiac arrhythmias, and 30-day all-cause mortality were compared.
Results:
Patients with LVDD were older (62.7 ±6.3 years vs. 55.9 ±12.3 years, p = 0.017) and were more often female (57% vs. 31%, p = 0.026). In addition, patients with non-alcoholic steatohepatitis (NASH) were more likely to have LVDD (48% vs. 12%, p = 0.001). In contrast, patients with alcoholic liver disease were less likely to have LVDD (10% vs. 33%, p = 0.032). In a multivariate logistic regression analysis, NASH (OR = 4.4 [95% CI: 1.33-14.5], p = 0.015) and female gender (OR = 3.31 [95% CI: 1.09-9.99], p = 0.033) were independent predictors of LVDD.
Conclusions:
In our cohort of patients, the presence of NASH was associated with a higher risk of LVDD. However, presence of LVDD did not influence immediate post-transplant outcome or 30-day all-cause mortality.
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